Nigeria health system

Nigeria has a pluralistic health care system with public and private health providers, with both modern and traditional health care systems. Health care provision is the concurrent responsibility of the three tiers of the Government.  

Federal Government 

The Federal Government is responsible for tertiary health care and also formulates health policies through the Federal Ministry of Health (FMOH). This level also provides specialised services through the teaching hospitals, Federal medical centres, specialist hospitals and medical research Institutes. In addition to tertiary health care provision, the FMOH leads the implementation of the NMEP. 

State Governments  

The State Governments provide largely secondary health care through the state General Hospitals and occasionally tertiary care through the State-owned Teaching Hospitals, they also coordinate PHC implementation at the Local Government Area (LGA) level through the State Primary Health Care Development Agency (SPHCDA). The State governments adapt national policies and strategies; and lead implementation of the AIDS, TB and malaria programme interventions; and health strategies and priority activities, at the operational level. 

Local Government Areas 

The Local Government Areas (LGAs) also manage the ward health committees, village health committees, private health care providers, and traditional and alternative health care providers that enhance service delivery and community mobilisation. 

Tertiary Level 

  • Federal Government-run 
  • Teaching and Specialist Hospitals 
  • Federal Medical Centres 
  • Private clinics and hospitals 

Secondary Level 

  • State Government-run 
  • General Hospitals 
  • Private clinics and hospitals 

Primary level 

  • LGA-run 
  • Community-based care 
  • Primary and Comprehensive Health Centres (PHC and CHC) 
    • Level 5: The medical officer of health (MOH) is a medical doctor who supervises a group of primary health care centres (PHCs) in each LGA.  
    • Level 4: A nurse/midwife heads a PHC and consults with the supervisory MOH in difficult cases. In LGAs where there are no medical officers, the most senior nurse deputises as supervisor. 
    • Level 3: Community Health Officers (CHOs) are next in rank to Nurses and head the PHC in the absence of a nurse. CHOs initially train as  Community Health Extension Workers (CHEW) but have received an additional year of training in a Teaching Hospital. 
    • Level 2: Community Health Extension Workers (CHEWs) who hold a 3 year diploma in community healthcare from Schools of Health Technology 
    • Level 1: Volunteer Health Workers (VHWs) and traditional birth attendants are informally trained and ad-hoc staff to help the PHC with case finding and community engagement. 
Private clinics 

The Government of Nigeria, at both Federal and State levels, provides financing for health services; however, most health expenses are borne by families and individuals as ‘out-of-pocket expenses’ (OOPE), while limited health insurance services are available.